Provider Demographics
NPI:1760456669
Name:BETHLEHEM OPHTHALMOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:BETHLEHEM OPHTHALMOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-691-3092
Mailing Address - Street 1:522 DELAWARE AVENUE
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015
Mailing Address - Country:US
Mailing Address - Phone:610-691-3092
Mailing Address - Fax:610-691-2041
Practice Address - Street 1:522 DELAWARE AVENUE
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015
Practice Address - Country:US
Practice Address - Phone:610-691-3092
Practice Address - Fax:610-691-2041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD422118207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA20026200OtherAMERIHEALTH MERCY
PA50020154OtherCAPITAL BLUE CROSS
PA3257853OtherAETNA US HEALTHCARE
PA2172412000OtherINDEPENDENCE BLUE CROSS
PA7078655OtherGATEWAY HEALTH PLAN
PA0019611260001Medicaid
PA7150459OtherAETNA
PABE1478891OtherHIGHMARK BLUE SHIELD
PA3257853OtherAETNA US HEALTHCARE
PA072136Medicare ID - Type Unspecified